Companies often need to elicit from other companies. For example, companies providing insured services (those who are paid in whole or in part by a party under a contract obligation, other than the party receiving the service) need certain information upon, or prior to acceptance of work, or delivery of services. In an insurance context, examples of the information needed may include:    Validity of Coverage            Dates and what procedures are covered        Limitations        Co-Payments        Maximums        Deductibles        Thresholds        Reimbursement rates            Contractual Obligations of Provider and PayerIn some instances it may also be necessary to receive a specific authorization prior to rendering a service.
Obtaining information of this nature is currently done either through a computer to computer transaction using an electronic data interchange (“EID”) format or via telephone call from the service provider to the payer (i.e. insurer).
In an effort to streamline the flow of information and to minimize costs, payers have begun making information of the type described above available as interactive transactions over the internet to their website or web portal. As a result, time consuming and therefore expensive phone calls tying up the personnel time of the payer and the provider can be minimized as the provider can interactively query the payer's website to obtain this information. The information on the payer web portals is often more comprehensive than that available over EID transactions.
As an alternative to providers obtaining the information directly themselves, some third-party data sources will aggregate and provide such information on a fee-per-transaction basis.
Unfortunately, each of these common methods of obtaining information has recognized problems. EID data is often missing or incomplete. Telephone calls are very expensive due to personnel costs. Interactively accessing a payer's website is expensive, due to personnel costs associated with both extracting information from the websites and learning to navigate various payer websites, each of which may be unique in the presentation of information. Finally, third-party data sources are expensive and may raise concerns regarding the accuracy of data provided.
Accordingly, there is a need for tools and techniques that automate the process of querying payer web portals to acquire necessary information and authorizations while minimizing or eliminating expenditure of personnel time.
Automating the process of extracting information from payer web portals in an automated manner would ideally enable processing an inbound request from another program (or “external process”) that supplies the information recovery system with search and navigation parameters, payer information, provider information and patient demographics to perform the desired search against the payer's web portal. However, development of such an automated system has proven very difficult for at least the following reasons:    Each payer's website is different in content and format.    Each payer's website is different in navigation rules.    Navigation to the needed data can be very complex.    Privacy rules require that users accessing a web portal be authorized to do so. In healthcare, the proof of authorization is referred to as a “credential” and a valid credential must be used to access the web portal.    Each provider has a very small number of credentials available for each payer.    There generally are too few credentials to really use or to attach to a session for extended periods.    Each credential may generally only be used serially. Any attempt to use a credential in more than one concurrent process will often be read as a security breach by the target web portal and the credential may be invalidated for future use.    A payer web portal may have a limited number of concurrent processes that may access it. This may be per source, per provider or in total for the site.
Hence, there is a need for more robust tools and techniques for accessing payer website data in an automated fashion.